Provider Demographics
NPI:1497816938
Name:ELLIOTT, AMY COYLE (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:COYLE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:254-202-9330
Mailing Address - Fax:254-202-9349
Practice Address - Street 1:140 HILLCREST MEDICAL BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8897
Practice Address - Country:US
Practice Address - Phone:254-202-8980
Practice Address - Fax:254-730-2692
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA00517363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5589Medicare PIN
TXS57449Medicare UPIN